August 28, 2000
Volume XXXIII, No. 32



HSC Profile



Physician assistants: more than just a helping hand

Allied Health

The idea of assisting physicians with the expertise of physician assistants (PAs), especially in rural areas, is not a new one. In fact, the Health Science Center has been collaborating with the military since 1995 to train PAs to be more than just a helping hand.

This 35-year-old profession has matured. On August 19, white coats were given to 20 PA students in the inaugural School of Allied Health Sciences PA class.

In some rural areas, the PA is the only primary care provider available.

"The goal of training PAs, especially those whom we hope will serve the people of South Texas, is tied to the missions of the Health Science Center, " said Dr. Dennis Blessing, chair of the Department of Physician Assistant Studies.

"Working with a physician’s supervision, PAs perform about 80 percent of a physician’s services, from taking a detailed patient history to performing physical exams, conducting patient education and also prescribing medications."

But the helping hands of PAs shouldn’t be confused with those of medical assistants, who perform routine clinical and clerical tasks. As part of their comprehensive responsibilities, PAs also assist in surgery; provide follow up; diagnose and treat illnesses; order and interpret tests; and counsel on preventive health care. These health care professionals are licensed to practice medicine with physician supervision.

Physicians generally handle the more complicated medical cases or those that require care outside the PA’s scope of work. Referral to the physician, or close consultation among patient, PA and physician, is done for unusual or difficult cases. PAs are taught to know their limits and refer to physicians appropriately.

Physician assistants assist in surgery, provide follow-up, diagnose and treat illnesses, order and interpret tests and counsel on preventive health care. Kenneth Lee (shown with wife, Susan, and son Aidan) was among the 20 new students who received their white coats during the "Frank Tejeda White Coat" ceremony.

"We’ve established a rigorous program that mirrors a medical student’s curriculum," said Dr. Blessing. "While the prerequisite minimum is two years of college, 18 of our students have either an associate’s or bachelor’s degree."

According to the American Academy of Physician Assistants (AAPA), the typical applicant already has a bachelor’s degree and more than four years of health care experience. Nurses, emergency medical technicians and paramedics commonly enter PA programs.

PAs are trained in intensive education programs, such as the one at the Health Science Center, accredited by the Commission on Accreditation of Allied Health Education Programs. The average program curriculum is 111 weeks, compared with 155 weeks for medical school. On a parallel track with medical school training, PA programs include courses in anatomy, physiology, biochemistry, pharmacology, physical diagnosis, pathophysiology, microbiology, clinical laboratory sciences, behavioral sciences and medical ethics.

Following the basic science and medical science classroom work, PA students enter the clinical phase of training. This includes classroom instruction and clinical rotations in medical and surgical specialties such as family medicine, internal medicine, obstetrics and gynecology, pediatrics, general surgery, emergency medicine and psychiatry.

In the mid-1960s, physicians and educators recognized there was a shortage and uneven distribution of primary care physicians among regions. To expand the delivery of quality medical care, Dr. Eugene Stead of Duke University Medical Center in North Carolina put together the first class of PAs in 1965. He selected Navy corpsmen who received considerable medical training during their military service and during the Vietnam War but who had no comparable civilian employment. He based the PA curriculum in part on the fast-track training of doctors during World War II.

More than 30 years ago a group of physicians, looking critically at America’s health care needs, envisioned a new type of health professional. Their hypothesis—physicians could treat more patients, utilize time and talents more wisely, and provide better care, if they worked with assistants who were trained in medicine and practiced with physician supervision. This idea gave birth to the PA health profession.

PAs are found in all areas of medicine. Today, according to the AAPA, more than 50 percent of all physician assistants practice what is known as "primary care medicine" —family medicine, internal medicine, pediatrics and obstetrics and gynecology. About 19 percent are in surgery or the surgical subspecialties.

"Prior to graduation a PA student will have completed 2,000 hours of supervised clinical practice and we require all students to do at least one rotation in a rural area," said Dr. Blessing. "PA practice is centered on patient care and may include educational, research and administrative activities."

PAs also practice in ambulatory, emergency, inpatient and long-term-care settings. They deliver health care services to diverse patient populations of all ages with a range of acute and chronic medical and surgical conditions.

PAs’ knowledge and skills allow them to function in a dynamic health care environment. The Health Science Center’s program facilitates their integration into the health care field by offering a bachelor’s degree in Physician Assistant Studies that uses a two-plus-two academic format. Two years of general education and program prerequisites taken at a regionally accredited college or university are followed by two-plus years of professional studies. There are 12 months of academic coursework at the School of Allied Health Sciences and other academic facilities in San Antonio and 15 months of supervised clinical practice at various facilities in South Texas.

Graduation from an accredited PA program and passage of the national certifying exam are required for state licensure. There are currently 123 accredited programs, six of which are in Texas, but an explosion of interest in the PA profession is resulting in the establishment of many new educational programs, including the one at the School of Allied Health Sciences that prepares health professionals to become essential members of the health care delivery team––more than just a helping hand.